The Best Medical Aids
The Best Hospital Plans
Overall, the CompCare Umbono Medical Aid Plan, previously named NETWORX Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and GP consultations to up to 3 Family Members. The Medihelp MedAdd Medical Aid Plan starts from R520 ZAR.
👤 Main Member Contribution | R520 |
👥 Adult Dependent Contribution | R520 |
🍼 Child Dependent Contribution | R520 |
🔁 Gap Cover | None |
📉 Annual Limit | Unlimited |
💙 Hospital Cover | Unlimited |
💶 Prescribed Minimum Benefits | ☑️ Yes |
🔵 Screening and Prevention | ☑️ Yes |
🟦 Medical Savings Account | None |
➡️ Maternity Benefits | ☑️ Yes |
The CompCare Umbono (NETWORX) medical aid plan is one of 9, starting from R520, and is a comprehensive hospital plan that covers 100% of the scheme or agreed tariff, provides unlimited oncology benefits, specialist and GP consultations, and more.
Other Plans provided by CompCare Include:
It should be noted that a Late Joiner Fee applies to all CompCare plans.
Gap Cover is not available on the CompCare Umbono Student Plan. CompCare offers 24/7 medical emergency assistance. According to the Trust Index, CompCare has a trust rating of 3.4.
💶 Income Bracket | 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
Student | R520 | R520 | R520 |
🟥 Hospitalization Private Hospitals Nursing Homes | Unlimited coverage in private hospitals. Covered up to 100% of the scheme rate. Subject to pre-approval, case management, and scheme protocols. |
🟧 Efficiency Discounted (ED) Members can choose Designated Service Providers (DSPs) for in-hospital services and chronic medicines to receive discounts. Voluntary admission to a non-Netcare facility requires a 30% co-payment of R7 500 – Not applicable to emergencies. Non-DSP pharmacies require a 25% co-payment. | A network of private and public hospitals is available. |
🟨 Overall Annual Limit | Unlimited |
🟩 GPs and Specialists | Covered up to 100% of the scheme rate. Subject to pre-approval and scheme protocols. |
🟦 Medication in-hospital | Covered up to 100% of the cost. |
🟪 Medication upon discharge from the hospital | Subject to Reference Pricing (RP) and Formularies. Limited to 7 days’ supply at R330. |
🟥 Surgical Prostheses | Unlimited cover for PMBs. |
🟧 Auxiliary Services | Limited to R2,970 per family for non-PMBs. Covered up to 100% of the agreed tariff. |
🟨 Psychiatric In-hospital Treatment | Covered up to 100% of the scheme rate. Subject to pre-authorization, protocols, and PMBs. |
🟩 Psychology (non-psychiatric admissions) | Only PMBs are covered. Limited to 21 days. |
🟦 All specialized radiology MRI scans CT scans PET scans | Covered up to 100% of the agreed tariff (AT). Subject to pre-approval and case management in the Designated Service Provider (DSP) Network. |
🟪 Basic Radiology | Covered up to 100% of the scheme rate. Unlimited cover but subject to scheme protocols. |
🟥 Pathology | Covered up to 100% of the agreed tariff. |
🟧 Confinements for Maternity | Covered up to 100% of the agreed tariff. Subject to pre-authorization and clinical protocols. Beneficiaries must register on the CompCare maternity program. Limited to 2 x 2D scans paid according to the AT. |
🟨 Rehabilitation in-hospital Alcoholism Drug Dependence Narcotics | Unlimited cover for PMBs. |
🟩 Organ Transplants, Plasmapheresis, Renal Dialysis | Unlimited cover for PMBs. |
🟦 Professional Sports Injuries | Subject to pre-approval. Scheme protocols will apply. |
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🩺 Oncology Chemotherapy Radiotherapy | Covered up to 100% of the AT. Unlimited cover for PMBs. |
🧪 Biological agents and Specialised Medication | Unlimited cover for PMBs. |
💙 Step-down facilities, hospice, rehabilitation | Covered up to 100% of the AT. Subject to pre-approval and protocols. |
➡️ Surgical Procedures performed out-of-hospital | Covered up to 100% of the AT. Subject to pre-approval and protocols. |
🩹 Wound care instead of hospitalization | Covered up to 100% of the AT. Unlimited cover for PMBs. Subject to pre-approval and protocols. |
☀️ Day-to-day Benefits and Limits | If services are rendered by Universal Network Providers, benefits will be paid at 100% of the scheme rate up to specified limits. Specialist visits, basic dentistry, optometry, and nonformulary prescription medication are subject to the Annual Flexi Benefit (AFB), limited to R3,780 per beneficiary and R5,570 per family. |
👨⚕️ General Practitioner (GPs) Consultations | Unlimited at the member’s Universal Network GP. Two additional visits per beneficiary at Universal Network GPs. Limited to two visits per beneficiary outside the Universal Network annually. Out-of-network visits require a 20% co-payment at the time of service, up to R1,950 per event (including medicine, pathology, and radiology), excluding facility fees. |
👩⚕️ Specialist Consultations | Covered up to 100% of the scheme rate. Limited to two visits per beneficiary and a maximum of 3 per family yearly. Subject to referral by a GP in the DSP network. Pre-approval is required for each specialist visit. Referrals are limited to specialists in the DSP hospital network. Subject to the Annual Flexi Benefit. |
💊 Chronic Medicine | Formulary reference price applies. Unlimited for the 26 CDL conditions if prescribed and dispensed by a Universal Network provider. Unless pre-authorized by the medical advisor, members pay for out-of-network chronic and nonformulary medicines. PMB rules will apply. |
🤧 Acute Medicine (Schedule 3>) | Unlimited if prescribed by a Universal Network GP or a specialist referred by one. Subject to the formulary. Pre-authorized non-formulary drugs are covered. The cover is not provided for non-DSPs or specialists without a Universal Network GP referral. |
⚠️ Basic Radiology Black and White X-Rays Ultrasounds | Covered up to 100% of the scheme rate. Unlimited if clinically appropriate and referred by a Universal Network GP. Limited to a specified code list. Subject to case management. There is benefit unless referred by a Universal Network provider or a specialist referred by a Universal Network GP (except when involuntary). |
🧪 Specialized Radiation MRI scans CT scans PET scans | Covered up to 100% of the scheme rate. PMBs will apply. Subject to pre-approval and case management. |
🅰️ Pathology | Covered up to 100% of the scheme rate. Unlimited cover when referred to in the DSP network. Subject to referral by a DSP network GP. Subject to a limited list of codes. No benefit unless referred by a Universal Network provider or a DSP network GP to a specialist (except when involuntary). |
🅱️ Conservative Dentistry Consultations Preventative Care Fillings Extractions Infection Control | Limited to one consultation per beneficiary yearly. Limited to R1,950 per beneficiary. Limited to R3,300 per family. |
🦷 Specialized Dentistry Maxillo-facial and oral surgery In and Out-of-hospital combined limit | Unlimited cover for PMBs. A quote is necessary for approval before treatment is started. Orthodontic treatments cannot be done on beneficiaries 18>. |
😎 Optometry | Subject to the AFB. Limited to 1 visit per beneficiary every two years. |
🤓 Lenses and Contact Lenses | Limited to R1,100 for clear plastic single lenses or R1,750 for bifocal lenses (every second year). Subject to AFB. Contact lenses are not covered under this plan. |
🥸 Frames | Included in the Lenses benefit. |
Allied Services Speech Therapists Social Workers Podiatrists Occupational Therapists etc. | Physiotherapy is subject to AFB. Unlimited cover for PMBs for all other services. |
📌 Clinical Psychologists | Unlimited for PMBs. |
📍 Surgical and Medical Appliances Wheelchairs Crutches Glucometers Artificial eyes External fixators | Pre-approval is required. Unlimited for PMBs. |
🧠 Psychiatry | Unlimited for PMBs. |
🥰 Psychosocial Counselling | Paid from risk. Unlimited telephonic counseling via the Universal Wellness Care Centre. The benefit provides one-on-one sessions with qualified psychologists, social workers, or registered counselors. Limited to 3 referral sessions per beneficiary yearly. |
😮💨 Oxygen Home Ventilation | Subject to PMBs and certain protocols. Unlimited for PMBs. Pre-approval is required. |
🏠 Home Nurse Visits | Pre-approval is required. Unlimited for PMBs. |
🚑 Emergency roadside assistance and ambulance transport (Netcare 911) | Covered up to 100% of the scheme rate. Netcare 911 must authorize non-emergency transportation within 24 hours or risk a 25% co-payment. |
✈️ International Travel Benefit Healthcare services outside South Africa | Subject to benefits per individual benefit category. All claims are paid according to South African rates. Members must register their journey and get a travel certificate to qualify for cover. |
🧬 Hospital Emergency room and casualty emergency visits (no admission and excluding facility fees) | Covered up to 100% of the scheme rate. Subject to certain protocols and PMBs. |
🟦 Lipogram | Limited to one fasting lipogram per beneficiary 20 years> once every 5 years. |
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🔎 Wellness, Lifestyle, and Preventative Care | Paid from Risk unless otherwise Indicated |
🩸 Blood Pressure | Limited to R275 per beneficiary 18 years> once a year. |
🍬 Blood Sugar | Limited to R275 per beneficiary 18 years> once a year. |
🩺 Cholesterol | Limited to R275 per beneficiary 18 years> once a year. |
🔟 Body Mass Index Measurement | Limited to R275 per beneficiary 18 years> once a year. |
💉 Flu Vaccines | Once a year for each beneficiary. |
😷 COVID 19 Benefit | Unlimited for PMBs. |
🍼 Newborn to Adult Benefit | Oral contraceptives are limited to R180 per beneficiary per month for female beneficiaries up to 55 years. Subject to protocols |
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The following chronic conditions are covered under the Umbono plan:
and many more.
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The following are some of the exclusions on the CompCare Umbono / NETWORX Plan:
Frail care services will not be covered, including accommodation and nursing care in convalescent or nursing homes catering to the aged or chronically ill.
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Prospective members must disclose all details of any past medical condition or treatment. Furthermore, waiting periods are applied when joining the scheme or registering new dependents. In terms of the CompCare Umbono plan, the following applies:
Members are responsible for submitting all claims within the required time frame.
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🔎 Medical Aid Plan | 🥇 CompCare NETWORX | 🥈 Bonitas BonCap Plan | 🥉 Bankmed Basic |
👤 Main Member Contribution | R520 | R1,430 | 1,320 – 2,538 ZAR |
👥 Adult Dependent Contribution | R520 | R1,430 | 987 – 1,902 ZAR |
🍼 Child Dependent Contribution | R520 | R673 | 332 – 636 ZAR |
📉 Annual Limit | Unlimited | Unlimited | Unlimited |
💙 Hospital Cover | Unlimited | Unlimited | Unlimited |
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CompCare’s Umbono, previously named NETWORX Student plan is a hospital that provides students with comprehensive medical coverage. The plan covers hospitalization costs at any private hospital, with access to over 600 hospitals across South Africa.
One of the plan’s key features is the unlimited oncology treatment program at CompCare’s designated oncology service provider, subject to treatment protocols. The plan also includes emergency medical assistance, which provides access to paramedics, doctors, and nurses 24/7.
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The Umbono plan is a hospital plan offered by CompCare that covers members for hospitalization and related expenses.
The Umbono plan offers various benefits, including hospitalization coverage, chronic medication benefits, preventative care, maternity benefits, dental benefits, mental health coverage, and prescription drug benefits.
No, the Umbono plan does not gap cover which would typically help cover any additional expenses incurred during hospitalization.
Preventative care benefits of the Umbono plan include regular health screenings, vaccinations, and wellness programs to help prevent illness.
Yes, the Umbono plan covers maternity benefits, including pre-and postnatal care and childbirth expenses.
The Umbono plan offers dental benefits, including oral exams, fillings, extractions, and dentures.
Yes, the Umbono plan covers mental health treatment, including therapy and medication.
Yes, the Umbono / NETWORX plan covers oncology treatment, including chemotherapy and radiation therapy.
The Umbono plan covers chronic medication benefits, including medication for conditions such as diabetes, hypertension, and asthma.
To join the Umbono plan, you must be a member of CompCare. You can apply for membership online or by contacting their customer support team.
Yes, the Umbono plan covers prescription drugs, including those prescribed during hospitalization.
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